Provider Demographics
NPI:1629068333
Name:OLAN, WAYNE J (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:J
Last Name:OLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 PENNSYLVANIA AVE NW
Mailing Address - Street 2:SUITE 7-420
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037
Mailing Address - Country:US
Mailing Address - Phone:202-741-2750
Mailing Address - Fax:202-741-2742
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW
Practice Address - Street 2:SUITE 7-420
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-741-2750
Practice Address - Fax:202-741-2742
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00451612085R0202X, 2085N0700X
MDD451612085R0202X
DCMD200112085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
116399G23Medicare ID - Type Unspecified
F64601Medicare UPIN